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03/07/2002 12:.51 FAX 209 9480621, -KLEINFELDER - - 'WJv°LSuv` f <br /> DATERCCEIVED - ( � EMD LOG NUMEER <br /> SAN�dAQUIN COUNTYPUBLIC HEALTH <br /> ENVIRONMENTAL HEALTH DIVISION <br /> FJo(I<< t1i^rt(I i. HFAI.)If.04EASTWEBER AVENUE,THIRD FLOOR 710 <br /> a F111r(( ) <br /> STOCKTON CA 95202 <br /> . (209)468-3420 <br /> 02 HAR -7 plPVENC RECORDS RELEASE�APPLICATION <br /> APPLICANT- � �/P / "14a�2y�'� BUSINESSIAGENCY <br /> ADDRESS .,�8�a5 /V�•�i-f/.G .a4 <br /> . PHONE �'T�S `• /�.� FACSIMILE- GI <br /> TENTATIVE APPOINTMENTeg�DA/7TSE I <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.$87.00 EE-REUEST on <br /> 1pleasiv7 to 10 uEners dayP Dm d 3p6 INESS BAYS) <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY _ <br /> v <br /> PROGRAM ELEMENTS SEARCH <br /> 1.0.r1ne -S 4- 254044'4.. CA - - <br /> 110 64 3l6dri- &f Sda<Gc lo., .CA 35 - . <br /> Aop Filbsr S14 - SI-4T<k#. C <br /> s•f Sr4 cL b CrJ <br /> I <br /> -716 /.5 /"linecrq 352 .2 <br /> ,i6 ety S.i- SfocL& c <br /> W/ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑. HOUSING ABATEMENT IR SOLID WASTE FACILITY <br /> .. G BOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> VUNDERGROUND TANK(MONITORINGIREMOVAL) _U DOG KENNEL ' ❑ DAIRY <br /> WHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> U(TIERED PERMITTED FACILITY Cl MOTEUHOTEL In PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATfOOIBODY PEIRCING C:1POOUSPA - - 13LAND USE APPLICATION SITES- <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review, A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> CNN 14 OMTM - - - <br />